EMUC 2020: COVID-19 and GU Cancer Care: The Radiation Oncologist's Experience

Dr. Tharmalingam notes that with regards to muscle-invasive bladder cancer (MIBC) there have been significant changes in referral patterns at her institution since the beginning of the pandemic. Starting in March 2020, there was a significant increase in the use of radiotherapy for MIBC, given the cut-down in elective surgery (ie. for radical cystectomy) during the first lockdown in the United Kingdom. Not surprisingly, there was also a significant and steep drop-off in prescribing of neoadjuvant chemotherapy prior to radiotherapy:

In terms of dose and fractionation for bladder cancer radiotherapy, Dr. Tharmalingam notes that in an effort to reduce patient contact during the pandemic, there has been an increase in hypofractionation (52.5-55 Gy/20#) in the months of March to May 2020.

Moving on to prostate cancer, Dr. Tharmalingam highlighted that the United Kingdom has adopted the RADS model first developed by Dr. Dan Spratt and further advocated during the pandemic.¹ This includes:

• Remote visits (telehealth)
• Avoid radiation (increasing use of active surveillance)
• Defer radiation (for six months among those on androgen deprivation therapy (ADT)
• Shorten Radiation (hypofractionation)

Dr. Tharmalingam also notes that most centers in the UK utilize the five fraction SABR protocol for low and intermediate-risk prostate cancer. Overall, she states that there has been an accelerated move towards hypofractionation across all tumor sites.

Dr. Tharmalingam concluded by highlighting that the radiation oncology community has been forced to develop “forced agility”, with a significant IT investment, increased use of telemedicine, virtual multidisciplinary tumor boards, and increased utilization of hypofractionated radiotherapy.

Presented by: Hannah Tharmalingam, MD, Clinical Research Fellow, Vice-President for Clinical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom